Provider Demographics
NPI:1326197096
Name:W.A.T.CH
Entity Type:Organization
Organization Name:W.A.T.CH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANTIONETTE
Authorized Official - Middle Name:B
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:910-275-0369
Mailing Address - Street 1:PO BOX 821
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NC
Mailing Address - Zip Code:28398-0821
Mailing Address - Country:US
Mailing Address - Phone:910-293-6300
Mailing Address - Fax:910-293-9973
Practice Address - Street 1:121 W PLANK ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NC
Practice Address - Zip Code:28398-1827
Practice Address - Country:US
Practice Address - Phone:910-293-6300
Practice Address - Fax:910-293-9973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38720251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900999Medicaid
NC8301727Medicaid